Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLSED AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION.
PLEASE REVIEW THIS NOTICE CAREFULLY
A. OUR PLEDGE REGARDING YOUR PRIVACY
Our practice is committed to maintaining the privacy of your health records. In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by federal law of assuring the confidentiality of your health information. We also are required by law to provide you with this Notice of Privacy Practices and the policies and procedures we will maintain in our practice to secure your individual identifiable health information (IIHI). We will also describe your rights and the obligations our practice has regarding the use and disclosure of medical information.
We are required by law to:
- Maintain the sanctity of your medical records
- To explain your privacy rights
- Our obligations concerning the use and disclosure of your IIHI
This notice pertains to all records in your IIHI that are created and retained by our practice. We have the right to revise this Notice of Privacy Practices as needed. Copies of this Notice are available to any patient and will be posted in each office.
B. IF YOU HAVE ANY QUESTIONS IN REFERENCE TO THIS NOTICE, PLEASE CONTACT:
Edward J. Ludwig III, FACMPE
Retina Vitreous Center, PA
1 Penn Plaza
New Brunswick, NJ 08901
(732) 568-1246C. HOW WE MAY USE AND DISCLOSE YOUR MEDICAL INFORMATION.
The following categories describe the different ways that we may use and disclose your medical information:
- Treatment. Our Practice may use medical information about you to provide you with medical treatment and services. For example, we may use your medical information to write a prescription for you or order laboratory tests. Many of the people who work for our practice - including, but not limited to, our doctors, nurses and technicians - may disclose your medical information in order to treat you or assist in your treatment. Additionally, we may disclose your IIHI to others who may assist in your care, such as your spouse, children or parents.
We may also disclose your medical information with other healthcare providers for purposes related to your treatment.
- Payment. We may use and disclose your medical information so that Retina Vitreous Center, PA can bill and collect payments from your health insurance or third party payers. For example, we may contact your health insurer to verify your eligibility for benefits and the extent of your treatment as permitted by your insurer. We may also provide your medical information to third parties that may be responsible for such costs, such as family members.
- Health Care Operations. We may use and disclose medical information about you for Retina Vitreous Center, PA operations. We may use your medical information to review and evaluate the quality of care you received from us or to conduct cost-management and business planning activities for our Practice. We may also remove personal information that identifies you from your records for the purposes of research or studies to improve the operations of the practice.
- Business Associates. We are permitted by law to use Business Associates to process our treatment, payment and/or health care operations. An example of a Business Associate is the company that maintains and transmits our insurance claims. For example, we may use a billing or accounting service to handle some of our billing and payments functions. We must enter into an agreement with these Business Associates to require them to maintain the confidentiality of your medical information and assure this information is used in accordance with HIPAA regulations.
- Appointment Reminders. We may use and disclose your medical information for the purposes of reminding you that you have an appointment with our practice.
- Treatment Options. We may use and disclose medical information to inform you of potential treatment options or alternatives.
- Health-Related Benefits and Services. We may use and disclose medical information to inform you of health-related benefits or services that may be of interest to you.
- Release of Information to Family/Friends. We may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who is helping you pay for your care.
D. USE AND DISCLOSURE OF YOUR MEDICAL INFORMATION IN CERTAIN SPECIAL CIRCUMSTANCE.
- Public Health Risks. Retina Vitreous Center, PA may disclose your IIHI to public health authorities for the purpose of:
- maintaining vital records, such as births or deaths
- reporting child abuse or neglect
- preventing or controlling disease, injury or disability
- notifying a person regarding potential exposure to a communicable disease
- notifying a person regarding a potential risk for spreading or contracting a disease or condition
- reporting reactions to drugs or problems with products or devices
- to notify people of recalls of products they may be using
- notifying the appropriate governmental authority regarding the potential abuse or neglect of an individual (including domestic violence). We will only disclose this information if the patient agrees or we are required by law to disclose this information
- Workers' Compensation. We may release medical information about you to workers' compensation programs. This information is needed to access medical disability.
- Health Oversight Activities. Our practice may disclose medical information to a health oversight agency for activities authorized by law. For example, information needed for audits, investigations, inspections and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
- Lawsuits and Similar Proceedings. Our practice may use or disclose your medical information in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We will make every effort to notify you before we release this information so that you have the opportunity to legally block the disclosure.
- Law Enforcement. We may release medical information if ordered to do so by a law enforcement official:
- In response to a court order, subpoena, warrant, summons or similar process
- To identify or locate a suspect, fugitive, material witness, or missing person
- In an emergency, to report a crime
- About a death we believe may be the result of criminal conduct
- Regarding criminal conduct at our offices
- In an emergency, to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime
- Coroners or Medical Examiners. We may release medical information to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. We may also release information to funeral directors in the performance of their job.
- Organ and Tissue Donations. Our practice may release your medical information to organizations that handle organs, eye or tissue procurement or transportation, including organ donation banks, as necessary to facilitate organ or tissue donation and transportation if you are an organ donor.
- Research. Our practice may use and disclose your medical information for research purposes in certain very limited circumstances. We will obtain your written authorization to use your medical information for research purposes except when an Institutional Review Board or Privacy Board has determined that the waiver of your authorization satisfies the following:
- the use or disclosure involves no more than a minimal risk to your privacy based on the following:
- an adequate plan to protect the identifiers from improper use and disclosure;
- an adequate plan to destroy the identifiers at the earliest opportunity consistent with the research; and
- adequate written assurances that the personal medical information will not be re-used or disclosed to any other party.
- the research could not practicably be conducted without the waiver;
- the research could not practicably be conducted without access to and use of the personal medical information.
- Serious Threats to Health or Safety. Our practice may use and disclose your medical information when necessary to reduce or prevent serious threat to your health and safety or the health and safety of another person. Any disclosures, however, would only be to someone able to help prevent the threat.
- Military. Our practice may release medical information if you are a member of the U.S. or foreign military forces (including veterans) if required by the proper military authorities.
- National Security. We may release medical information about you to federal officials for intelligence and national security activities authorized by law. We may also disclose your medical information in order to protect the President, other officials or foreign heads of state.
- Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. The release of information would be necessary for the following reasons:
- to provide health services for you,
- for the safety and security of the institution,
- to protect your health and safety or the health and safety of others.
E. YOUR RIGHTS REGARDING YOUR IIHI
You have the following rights regarding IIHI that we maintain about you.
1. Confidential Communications: You have the right to request that our practice communicate with you in reference to your health issues in a particular manner or location. For example, you can request that we only contact you at home and not work.
2. Right to Request Restrictions: You have the right to request restrictions or limitations in our use of your IIHI for purposes of treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone else who is involved in your care. For example, you could request that we not disclose information about your surgery or procedures that you had performed at our facilities.
We are not required to agree to your request. If we do agree, we are bound by our agreement not to release your information unless required by law, in the case of an emergency or when the information is necessary for your treatment. To request a restriction, we have available a form for you to complete which states clearly your wishes. Your request must be in writing and cover the following areas: (a) the information you want restricted; (b) whether you are requesting the limitation of our practice's use, disclosure or both; (c) to whom you want the limits to apply.
3. Inspection and Copies. You have the right to inspect and obtain copies of your medical information that may be used in your treatment plan. Usually, this includes medical and billing records, but does not include psychotherapy notes. You must submit your request in writing to the Privacy Officer at Retina Vitreous Center, PA, 1 Penn Plaza, New Brunswick, NJ 08901. Our Practice may charge for copies and labor involved in copying these records. We may deny your request to inspect and/or copy your medical records in certain circumstances. However, you have the right to request a review of our denial. Another healthcare provider from the practice will conduct the review.
4. Amendments. You may request us to amend your health information if you believe it is incorrect or incomplete. You have the right to request an amendment for as long as the information is kept by or for our practice. You must make the request in writing to the Privacy Officer at 1 Penn Plaza. Your request must list the reasons for your requested amendment(s). The practice may refuse your request for the following reasons:
- Information is accurate and complete.
- Medical information that was not created by us.
- Is not part of the medical information kept by or for our practice.
- Is not part of the information that you would be permitted to inspect and/or copy.
5. Accounting of Disclosures. All patients have a right to request an "accounting of disclosures." This is a list of certain non-routine disclosures that our practice has made of your medical information for non-treatment, non-payment or non-operations purposes. Use of your medical information for routine patient care is not required to be documented. For example, the billing department using your information to file insurance claims. You have the right to request an "accounting of disclosures" from the Privacy Officer at 1 Penn Plaza. This request must be in writing and cover a specific time period that may not be longer than six (6) years from the date of disclosure and may not include dates before April 14, 2003. Your first request within a 12-month period is free of charge. The Practice may charge for additional requests with the same 12-month period. There may be a cost for the additional request. Please contact the Privacy Officer for the costs.
6. Right to a Paper Copy of This Notice. You are entitled to receive a paper copy of our Notice of Privacy Practices. You may request a copy at any time. To obtain a copy of this notice, contact the Privacy Officer or the manager of this facility.
7. Right to File a Complaint. If you believe that your privacy rights have been violated, you may file a complaint with our Privacy Officer. After investigation of the issue and a decision is rendered, you may file a complaint with the Secretary of the Department of Health and Human Services. All complaints must be in writing. You will not be penalized for filing a complaint.
8. Changes to This Notice: We reserve the right to change this notice at any time. We reserve the right to make the revised or changed Notice effective for medical information we already have about you as well as any information we receive in the future. A current copy of this Notice will be posted in all of our offices. A copy of this notice may also be obtained at our website at http://www.retinavitreouscenter.com
